CMS drops 3 final payment rules: 12 things to know

CMS has released its annual payment updates for physicians and outpatient and home health services for 2022. 

Here are 12 takeaways from the trio of final rules published Nov. 2: 

Outpatient Prospective Payment System rule

1. CMS is increasing outpatient payment rates by 2 percent in 2022 for hospitals that meet applicable quality reporting requirements. 

2. CMS is modifying the hospital price transparency regulation beginning Jan. 1. Hospitals with 30 or fewer beds that aren't in compliance with the regulation will face a minimum penalty of $300 per day. Hospitals with more than 30 beds will face a minimum penalty of $10 per bed per day. The maximum penalty will be capped at $5,500 per day. A full year of noncompliance with the price transparency regulation would result in a maximum penalty of about $2 million per hospital. 

3. CMS is requiring that the machine-readable file that includes hospital prices be accessible to automated searches and direct downloads. 

4. The final rule halts elimination of the inpatient only list and adds back most of the services that were removed from the list in 2021.

5. CMS will continue paying hospitals 22.5 percent less than the average sales price for certain drugs and biologics purchased through the 340B program.

Read the 1,394-page rule here

Physician Fee Schedule rule

6. The conversion factor used to determine provider reimbursement will drop to $33.59 in 2022 from $34.89 this year as a temporary payment boost provided by the Consolidated Appropriations Act expires. 

7. CMS is amending the definition of interactive telecommunications system for telehealth services to include audio-only communications technology used to diagnose, evaluate or treat mental health disorders in certain cases. The agency also clarified that mental health services can include treatment of substance use disorders. 

8. The final rule will nearly double Medicare Part B payment rates for certain vaccines, including influenza, pneumonia and hepatitis B. CMS said it hopes the increase in payment rates — from $17 to $30 — will improve access and lead to greater vaccination uptake. 

9. CMS is updating the clinical labor rates that are used to calculate practice expenses under the Physician Fee Schedule for the first time in nearly two decades. As a result, payments to primary care specialists that involve more clinical labor, such as geriatrics and family practice, are expected to increase.

Read the 2,414-page rule here

Home Health Prospective Payment System rule 

10. Medicare home health reimbursement rates will increase by 2.6 percent, or $465 million, in 2022.

11. The final rule expands the home health value-based purchasing model nationally, with the first performance year beginning Jan. 1, 2023. Starting in 2025, CMS will adjust fee-for-service payments to Medicare-certified home health agencies based on the quality of care provided to beneficiaries during the 2023 performance year.

12. The final rule implements provisions of the Consolidated Appropriations Act that establish survey and enforcement requirements for hospice programs that serve Medicare beneficiaries. 

Read the 558-page rule here

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